Pier Health Resource Centre manager Craig Plain says the alleyway behind his 223 Main Street pharmacy is a popular destination for drug users. Earlier this year, Plain discovered a man overdosing in the alleyway and was able to save his life with naloxone. (Chung Chow photo)

Saving lives in Downtown Eastside

Craig Plain knew something was amiss when a long-term client in Vancouver’s Downtown Eastside stopped coming into his pharmacy.

It was near Christmas this past year, and Plain and his staff at Pier Health Resource Centre (223 Main St.) started to ask around the tight-knit community if anyone had seen the missing client.

“Nobody knew where he was, but we knew where he lived,” Plain, 37, told Peace Arch News last week.

“Sure enough, we went up to his room and found him, it was far too late… which really shook us. Just a totally sweet guy, worked very hard in the Downtown Eastside to make the Downtown Eastside better.”

In the weeks leading up to the tragedy, Plain, who was born and raised in South Surrey and has been pharmacy manager at Pier Health for two years, had been working with the BC Centre for Disease Control to make naloxone – the life-saving overdose antidote – more accessible.

At the time, the BCDC was providing different Downtown Eastside health-care units – including Insite – with free naloxone kits. Pharmacies, however, were forced to charge patients about $50 for a kit.

“Obviously for $40-$50 for two naloxone ampules, that’s not really feasible. People on Downtown Eastside don’t have $50 to spend, especially when it’s not for them.”

Through its partnership with BCDC, Pier Health was the first pharmacy in B.C. to distribute free naloxone kits and training. The pharmacy received approval Dec. 22, but didn’t receive the free naloxone kits until January.

Not long after the approval, Plain used the antidote to save someone’s life.

Plain and other staff members were leaving the office for the day – they usually take the back door.

“We were pushing the door to get out, we couldn’t get out, something was stuck in the way.”

He assumed it was either a garbage can or bags blocking the door.

“We didn’t know what was going on. We just kept pushing and pushing.”

Eventually, Plain opened the door wide enough to peek around the corner.

“(We) saw this guy slumped over not responding to us at all,” Plain said. “We quickly ran up and got our naloxone kit and quickly ran down. We checked his pulse, his breathing – he had about a few breaths per minute, he was pretty low. We gave him the naloxone right off the bat and called 911. In about three minutes he went from unconscious to sitting up and looking at us.”

The man – who recovered from the near-fatal overdose – is now a client of Pier Health.

Addicts overdosing to the point of needing naloxone is now a daily occurrence in the Downtown Eastside, Plain said.

“Just two days ago there was another call,” he said Friday, adding that the owner of Pier Health looked out of his office window and saw a commotion.

“So I grabbed my kit and went outside,” Plain said.

He quickly administered naloxone to a man who was overdosing.

“I don’t know the end result of this guy, but most of our pharmacists in our clinic have given (naloxone) at least once.”

Since the beginning of this year, the pharmacy has handed out approximately 50 kits. He said there have been a few cases where Pier Health staff have heard people screaming in the streets for naloxone, “but so many people have the kits, we haven’t had to run out every time.”

For his leading work on the front line of the city’s opioid crisis, in June, Plain was named the 2017 Canadian Pharmacist of the Year by the Canadian Pharmacist Association.

Receiving the award, he says, is conflicting.

“I’m still understanding this trophy thing. I think the overdose and death count is about the highest it’s ever been and I’m standing here with a trophy for all the work I’ve done in Downtown Eastside. What have I done? The numbers aren’t going the way we want to see yet. These things we’re doing are very new and it will take a bit of time to see those overdose rates drop and the death rate get to, ideally, zero.”

He said he considers the trophy a victory for the people of Downtown Eastside, because the changes he’s made came from the residents of the neighbourhood.

“I also wanted to mention the importance of the staff at Pier Health that helped to get the recognition for the award. I certainly couldn’t have achieved it (with just) myself and the director/owner Bobby Milroy. We have put together an enthusiastic team and, more importantly, an open-minded group of health-care professionals that are careful not to judge or stigmatize people.”

Plain’s work now is a far cry from when he worked at Rexall in Ocean Park, notes his father, Dwight, who was a pharmacist for a combined 41 years in White Rock’s Central Plaza and Ocean Park Shopping Centre. The two worked together up until his retirement in 2011.

The elder Plain told PAN his son goes beyond the pharmaceutical requirement of the job.

“It’s different than other pharmacies. The other ones say here’s your (methodone) and here you go. Craig sits down, gives it to them, checks the patients for sores or anything else… They do deliveries, too, to the patients that can’t get out,” he said.

Dwight Plain agreed the Downtown Eastside is a different world.

“It is, yep. But they’re trying to change it,” he said.

Plain and his team are already beginning to carve a new path in pharmaceuticals, a path he expects the province – and, potentially, the nation – to soon follow.

His team is one of the first pharmacies in the Downtown Eastside to begin a hydromorphone injection program. Plain described the medication as a new alternative for people who have failed on methodone and suboxone drug therapies.

The staff are able to give patients hydromorphone through an IV in a controlled environment.

“I have seen many people break down in tears over the concept as they sat in the pharmacy,” Plain told PAN via email. “One person in particular said it was the first time in over 25 years that he didn’t feel like a criminal and wasn’t ashamed that he needed to use. Pretty powerful and intense emotions early on for this project.”

A graduate of Earl Marriott Secondary, SFU and UBC, Plain said he enjoys working in the Downtown Eastside, an area rampant with mental illness and addiction.

“It’s one of those areas in health care that if you’re not into it to make changes in peoples lives and improve health care, then you’re going to burn yourself out very quickly. If you’re there to milk the system and make money off prescriptions, the patients, the residents really see that.”

Pharmacists Dwight and Craig Plain were both familiar faces for years in South Surrey and White Rock. (File photo)